title: The safety and efficacy of noncorticosteroid triple immunosuppressive therapy in the treatment of refractory chronic noninfectious uveitis in childhood.
abstract: OBJECTIVE
  To assess the safety and efficacy of noncorticosteroid triple immunosuppressive therapy in the treatment of refractory chronic noninfectious childhood uveitis.
  
  
  METHODS
  Subjects were retrospectively selected from a database. Patients were included if they were diagnosed with chronic, noninfectious uveitis at 16 years of age or under and treated with triple immunosuppressive therapy for at least 6 months (following failure of a combination of 2 immunosuppressants). Patient demographics, diagnoses, duration of uveitis, drug dosages, active joint inflammation, and ophthalmologic data were recorded. Efficacy outcomes for triple therapy were recorded at 6 months.
  
  
  RESULTS
  Thirteen patients with bilateral uveitis were included. Using Standardized Uveitis Nomenclature (SUN) criteria, at 6 months only 11 eyes (42%) had a 2-step improvement in anterior chamber cell inflammation (n = 26). In addition, 2 patients required additional oral corticosteroid treatment. There were 4 significant infectious adverse events during a total of 21.9 patient-years (PY) on triple therapy (0.18 events per PY).
  
  
  CONCLUSIONS
  In this group of children with refractory uveitis, addition of a third immunosuppressive agent did not confer substantial benefit in redressing ocular inflammation and was associated with significant infections in a minority of patients.
authors.affiliation: From the School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol; Department of Pediatric Rheumatology, Bristol Royal Hospital for Children; Bristol Eye Hospital; Inflammation and Immunotherapy Theme, National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital National Health Service (NHS) Foundation Trust and University College London (UCL) Institute of Ophthalmology, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, England.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Little
authors.forename: Ethan S
authors.initials: ES
authors.lastname: Sen
authors.forename: Helen
authors.initials: H
authors.lastname: Strike
authors.forename: Annie
authors.initials: A
authors.lastname: Hinchcliffe
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Guly
authors.forename: Richard W J
authors.initials: RW
authors.lastname: Lee
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Dick
authors.forename: Athimalaipet V
authors.initials: AV
authors.lastname: Ramanan
mesh_terms: D000293:Adolescent; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy*
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008727:Methotrexate
keywords: IMMUNOSUPPRESSION; JUVENILE ARTHRITIS; UVEITIS